Hand Pathology Flashcards by Hannah Farquhar

What two structures form the carpal tunnel?

Carpal bones

Flexor retinaculum

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What passes through the carpal tunnel?

Median nerve

Nine flexor tendons - 4FDP, 4FDS, 1FPL

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What does the median nerve innervate?

Lumbricals 1 and 2
Opponens pollici
Abductor pollicis brevis
Flexor pollicis brevis

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Name the causes of carpal tunnel syndrome

Pregnancy 
Rheumatoid arthritis 
Diabetes 
Chronic renal failure 
Hypothyroidism 
Idiopathic 
Wrist fracture

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How will carpal tunnel syndrome present?

Parathesiae - thumb and radial 2 fingers
Worse at night
Loss of sensation
Weakness and clumsiness

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Describe the examination in suspected carpal tunnel

Tinel’s test positive - percuss over nerve
Phalen’s test - hyper-flex wrists (prayer)
Thenar atrophy

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What is the treatment for carpal tunnel?

Wrist splints
Steroid injection
Decompression under local anaesthetic

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What happens in Dupuytren’s Contractures?

Specialised palmar fascia undergoes hyperplasia forming nodes and contractors at MCP and PIP joints

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Describe the pathology of dupuytren’s

Proliferation of myofibroblast cells and abnormal collagen production (3 instead of 1), skin may be adherent to the fascia and puckered with palpable nodes present

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What fingers care commonly affected by dupuytren’s?

Little finger and ring finger

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What diseases can cause Dupuytren’s?

Familial 
Alcoholic cirrhosis 
Diabetes
Thyroid 
Epilepsy medication

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Name two disease associated with Dupuytren’s

Peyronies - penis

Leddrhose - feet

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Name three types of surgery that can be done on dupuytren’s

fasciectomy (removal of tissue)
fasciotomy (division of cords)
amputation

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What is a ganglion cyst?

Mucinous filled cyst found adjacent to a tendon/synovial joint

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What are the names for ganglionic cyst depending on location?

DIP - mucous cyst
Wrist - dorsal/volar
Knee - bakers cyst

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Describe the presentation of a ganglion cyst

Localised irritation/pain, firm smooth rubbery and should transluminate

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What deformity will radial nerve palsy cause?

Wrist drop - extensor muscles don’t contract

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What will median nerve lesion cause?

Distal - Ape hand

Proximal - hand of benediction

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What nerve damage will cause abnormal `OK’ sign?

Anterior interosseous

How will ulnar nerve damage present?

Ulnar claw - paralysis of 3rd and 4th lumbrical

Describe ulnar paradox

Ulnar nerve damage can denervate flexor digitorum profundis - weakens the flexion of IP joints in 4th and 5th joint

How does trigger finger arise?

Tendonitis of flexor tendon to a digit can result in nodular (scarring and fibrosis) enlargement.

Where does trigger finger usually occur?

Distal to fascial pulley over MC neck - the nodule catches on and may get stuck - A1 pulley
Middle and ring finger

How is trigger finger treated?

Steroid injection around the tendon

Surgery - incision of the pulley to allow the tendon to move freely - only A1 pulley

Name the condition which involves swelling of the sheet of the 1st dorsal compartment tendons

DeQuervain's Tenosynovitis

Which tendons are affected by DeQuervain's Tenosynovitis?

Abductor pollicis longus | Extensor pollicis brevis

How does DeQuervain's Tenosynovitis present?

Spontaneous red/swollen area proximal to the thumb

Name two tests for DeQuervain's Tenosynovitis

Finkelstein | Eichhoff's

How is DeQuervain's Tenosynovitis treated?

NSAIDs, splint, rest, steroids, decompression

What investigation should be done in DeQuervain's Tenosynovitis?

Xray

What is paronychia?

Infection within the nail fold - children or people who bite their nails

How is paronychia managed?

Elevate, antibiotics, incise and drain

What is a surgical emergency in the hand?

Flexor Tendon Sheath Infection

Describe flexor tendon sheath infection

Infection of sheath tracking up palm and arm - limited extension due to pain

What are Kanavel's cardinal signs?

Affected finger held in fixed flexion Fusiform swelling over finger Painful to percuss over sheath Painful on passive extension

Describe the 5 types of fingertip injury

``` 1 - soft tissue 2 - soft tissue and nail 3- soft tissue, nail and bone 4 - proximal 1/3 phalanx 5 - proximal to DIP ```

How are the 5 types treated?

1 and 2 - dressing 3 - repair bed and stabilise 4 - ablation 5 - V-Y flap

How can subungal haematoma be treated?

Pressure causes pain - burning a paper clip with a bunsen to relieve pressure and pain

What are the two types of surgery for hand fractures?

Closed reduction using K wires | Open reduction using plates

What is skiers/gatekeepers thumb?

Ulnar collateral ligament injury due to a fall on an outstretched hand

How is skiers thumb treated?

Splint | Surgical repair of ligament

Describe boxer's fracture and the treatment

Minimal displacement, no rotation | Buddy strap and early mobilisation of 5th MC near knuckle

What is Mallet finger?

Soft tissue injury or avulsion fracture results in injury to the tendon - straightens the end of the finger Tender/bruising resisted extension

What is the treatment for mallet finger?

Splint 24/7 for 6 weeks | Surgery in chronic cases

What is Bennett's Fracture?

Fracture at base of first metacarpal bone with subluxation or dislocation - pain swelling weakness in pinch grasp

How is Bennett's fracture managed?

Cast and rest | Closed reduction

What is eschar?

Thick, leathery inelastic skin which can form after burns - requires surgical release to allow movement